New oral anticoagulants-TURKey (NOAC-TURK): Multicenter cross-sectional studyServet Altay1, Özlem Yıldırımtürk2, Hüseyin Altuğ Çakmak3, Lütfü Aşkın4, Ümit Yaşar Sinan5, Feyzullah Beşli6, Ömer Gedikli7, Özge Özden Tok8
1Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
2Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey
3Department of Cardiology, Kaçkar State Hospital; Rize-Turkey
4Department of Cardiology, Palandöken State Hospital; Erzurum-Turkey
5Department of Cardiology, Cardiology Institute, İstanbul University; İstanbul-Turkey,
6Department of Cardiology, Faculty of Medicine, Harran University; Şanlıurfa-Turkey
7Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University; Samsun-Turkey
8Department of Cardiology, Bakırköy Sadi Konuk Training and Research Hospital; İstanbul-Turkey
Objective: New oral anticoagulants (NOACs) are increasingly used both for prevention of stroke in non-valvular atrial fibrillation (NVAF) and the treatment of venous thromboembolism (VTE). In this study, we aimed to evaluate the current patterns of NOACs treatment in Turkey. Moreover, demographic and clinical parameters and bleeding and/or embolic events under NOACs treatment were analyzed.Keywords: new oral anticoagulants, atrial fibrillation, embolic complication, bleeding
Methods: The New Oral Anticoagulants-TURKey (NOAC-TURK) study was designed as a multicenter cross-sectional study. A total of 2,862 patients from 21 different centers of Turkey under the treatment of NOACs for at least three months were included in this study. Demographic, clinical, and laboratory characteristics of study participants with their medications used were obtained through the NOAC-TURK survey database. Additional necessary medical records were obtained from electronic health records of participating centers.
Results: Of the 2. 862 patients, 1.131 (39.5%) were male and the mean age was 70.3±10.2 years. Hypertension was found as the most frequent comorbidity (81%). The most common indication for NOACs was permanent atrial fibrillation (83.3%). NOACs were mainly preferred because of inadequate therapeutic range or overdose during warfarin usage. The most frequent complication was bleeding (n=217, 7.6%), and major bleeding was observed in 1.1% of the patients. Embolic events were observed in 37 patients (1.3%). Rivaroxaban and dabigatran were both more preferred than apixaban. Almost half of the patients (47.6%) were using lower doses of NOACs, which is definitely much more than expected.
Conclusion: The NOAC-TURK study showed an important overview of the current NOACs treatment regimens in Turkey. Although embolic and bleeding complications were lower than or similar to previous studies, increased utilization of low-dose NOACs in this study should be considered carefully. According to the results of this study, NOACs treatment should be guided through CHA2DS2-VASc and HASBLED scores to ensure more benefit and less adverse effects in NVAF patients.
(Anatol J Cardiol 2017; 17: 000-00)
Corresponding Author: Servet Altay, Türkiye